Tag Archives: DSM

Do we want people to believe that BPD is a real psychiatric illness that they must manage for the rest of their lives, or do we want to promote a message of hope which says, “You can become free of your emotional distress and live the life that you want”?

By presenting BPD as a severe mental illness which can be managed but not cured, the medical model of the BPD label utterly fails to promote hope. Additionally, the medicalized concept of BPD is scientifically broken: It does not describe a valid illness which is consistent across a population.

Why do we keep using BPD if there is so much wrong with it? Is it possible that we would be better off without BPD?

And if BPD is should be abolished, what should replace it?

This article addresses how to replace BPD.

To this question, my first answer is “Nothing” – that we should simply abolish BPD – and my second answer is “Emotional Dysregulation Susceptibility Syndrome”, which I will explore as a hopeful alternative. Let’s discuss these options.

My central conceptual argument is that Borderline Personality Disorder as defined in the DSM is an unreliable, invalid concept. Given its current popularity, it’s not easy to fight against the prevailing notion of BPD as a valid mental illness. But after speaking to many people who also experience BPD as a flawed, discouraging concept, I am more resolute in this view than ever. If you are unfamiliar with the argument against BPD, please see here, especially Myth #5:

While I prefer to understand people without labels, due to practical considerations I contend that BPD should be replaced by a more hopeful label. This new label should refute the myth of BPD as a life-long mental illness and emphasize vulnerability to stress along a continuum.

My position against BPD directly opposes the thinking of many in the psychiatric establishment, including large organizations like TARA BPD, the Treatment and Research Advancements Association for BPD, and NEA BPD, the National Education Alliance for BPD.

TARA and NEA assert that BPD is a “serious psychiatric illness”, one which they can reliably investigate and for which they will create improved treatments. In my opinion, these medicalized viewpoints represent poor research and outright misinformation.

Let me list and critique some of National Education Alliance BPD’s main positions. I hope the reader will sense how badly NEA’s claims on BPD, which often border on outright lies, fail to meet the criteria for good science and basic common sense.

1) BPD is an “illness”.NEA’s position: BPD is a single illness which causes unstable mood and behavior.Edward’s response: BPD is not one unitary entity that causes anything. BPD is not a single illness because the symptom-cluster that supposedly represents BPD cannot be reliably identified by any biomarkers (genes, brain scans, etc.) nor reliably identified by different psychiatrists across a population, as the NIMH recently admitted.
The way a person understands their world based on past experience leads to unstable mood and behavior.

2) Genes are involved in causing BPD.NEA’s Position: Scientists generally agree that genetic and environmental influences are likely to be involved in causing BPD.Edward’s response: This is misleading on so many levels it’s hard to know where to start. Again, BPD is not one reliable entity. And there is no evidence that genes “cause” any of the distress-experiences denoted by the BPD misnomer – such thinking involves the mistaken assumptions that genetic and environmental factors work as separable influences in a quantifiable manner. I have written about these distortions extensively in my article on twin studies (#4).

3) Brain scans provide evidence that biological factors cause BPD.NEA’s position: There is evidence that biology is a factor in causing BPD, due to imaging studies in people with BPD showing abnormalities in brain structure and function.Edward’s response: Does NEA think the public cannot understand basic cause and effect? Of course seriously distressed people have observably different brains than “normals”. That doesn’t mean biology or genes cause these differences; neglect, abuse, and lack of love, which are much more prevalent in those labeled “borderline”, inevitably lead to different brain functioning. But that doesn’t even mean those things cause BPD or that BPD is real. Never take a difference for an illness.

4) Biological factors make people more likely to develop BPD.NEA’s position: The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk.Edward’s response: The current theory is a demonstrably false hypothesis. Constitutional vulnerability to stress may make it easier for some people to become overwhelmed by environmental stress, but that doesn’t mean that BPD is in any way a valid illness, nor that such people cannot become well. Plus biology and genetics do not act alone in the way implied in this reductionist model (see – http://www.madinamerica.com/2015/06/are-dsm-psychiatric-disorders-heritable/ )

5) The prevalance of BPD can be quantified.NEA’s position: BPD affects 5.9% of adults at some time in their lifeEdward’s response: Does anyone really believe that a subjective, descriptive label with no biomarkers can have its prevalence reliably identified to a tenth of a percentile?

6) BPD is a life-long mental illness.NEA’s position: People with BPD have BPD for life. (NEA stops short of saying this outright, but they imply it. Their website talks over and over about managing and reducing symptoms in “borderlines” of different ages, never once mentioning the possibility of becoming free of “the illness” or discussing the possibility of full recovery)Edward’s response: This is one of the most damaging myths being promoted about BPD. Problems that are mislabeled BPD can be fully recovered from; people who once approximated borderline criteria can eventually live a satisfying, emotionally normal life. Many thousands of people have already done so. Getting better is hard work, but people do not have to cope with and manage BPD for life. People need real hope, not the discouraging prospect of a life-long illness.

My Manifesto Against National Education Alliance for BPD

As can be seen, NEA BPD set themselves up as the experts on how to define and treat the BPD “illness”, an illness label they obviously intend to keep. But they may not have considered that former “borderlines” can see through their propaganda.

My position on NEA’s “BPD as a serious psychiatric illness” notion is this:

Severely distressed people do not have accept the label BPD as an identity nor as an explanation for their problems.

Emotional problems are not reducible to “psychiatric illnesses”, nor are they the exclusive province of psychiatry.

Effective help which often leads to full recovery from problems mislabeled BPD already exists. Recovering does not require the assistance of “experts on BPD”, nor does it require DBT and medications, although these can help. Also, people can have their own definition of recovery and a meaningful life.

Emotional problems mislabeled BPD can be completely healed and do not have to be managed for life.

It’s time to say goodbye to National Education Alliance’s harmful theories about BPD as a life-long psychiatric illness, to end the borrowed time these theories have been living on.

Why Reducing BPD’s Stigma is Doomed to Failure

I also oppose the message of blogs that attempt to put a positive spin on BPD, like “Make BPD Stigma Free”. In my opinion, reducing BPD’s stigma and building “BPD Pride” is doomed to failure. To me, these efforts resemble shifting deck chairs around on the Titanic. Similar attempts to reduce depression’s and schizophrenia’s stigma have foundered miserably; the problem is that reducing complex emotional issues to medical labels explains nothing and fails to empower people.

Two examples of such programs are instructive:

“Defeat Depression”, a large scale British campaign to reduce the stigma of Major Depressive Disorder, failed to reduce stigma and did not improve outcomes according multiple follow-up studies.

“Beyond Blue”, an Australian attempt to reduce the stigma of so-called mental illnesses, also backfired. Studies investigating its effect found that those who knew less about mental illness diagnoses, or who were given a diagnosis but rejected it, had better outcomes than similar people who believed they “had a mental illness.” This unsettling finding has been confirmed in John Read’s research (e.g. Models of Madness).

The disturbing conclusion of this research is that accepting that you have a “mental illness” – as opposed to rejecting the medical model of emotional distress – actually decreases the chances of recovery. This shocking Youtube presentation by critical psychiatrist Sami Timimi covers this and other eye-opening facts about “mental illness”:

If Defeat Depression and Beyond Blue failed to destigmatize depression, why should a destigmatization program for BPD succeed? Alongside “schizophrenia”, BPD is the most unreliable, invalid, confusing, harmful, stigmatized, and useless label. Even if BPD were to lose its stigma, it would remain an unreliable term that explains nothing about an individual’s problems.

Abolishing BPD – The Ultimate Goal

Borderline Personality Disorder can and should be entirely abolished. BPD should be consigned to history as a tragically misguided way of
concretizing emotional distress.

2) Label-Free Treatment: Psychotherapists and treatment programs would help distressed people without viewing them as borderline, no matter how much the client “fit” that outdated term.

3) Label-Free Family Understanding: Families would be helped to support their distressed members without being fed the fiction that their loved one “has BPD.” Parents, siblings, partners, and children would find that their loved ones’s problems can be understood without calling them borderline.

4) A New Research Paradigm: into severe emotional problems would cease to be focused around BPD. It would instead use the emotional dysregulation spectrum concept that I’m going to discuss. There would be more qualitative, experience-focused research, and less quantitative label-focused research.

5) Abolition of BPD and the DSM: BPD would be abolished from the DSM, as it has already been removed from ICD (Europe’s version of the DSM, from which BPD was recently voted to be dropped). Furthermore, as an unscientific fraud full of fictional illnesses, the entire DSM would be eviscerated.

In time, BPD would be viewed as an outdated relic, a sad symbol of an age where psychiatrists constructed bizarrely misguided labels for emotional distress. People in the year 2200 would look back on “BPD” in disbelief, much as people today look back at centuries-old conceptions of physical illnesses. BPD would be mocked alongside notions of evil spirits released by bloodletting and plagues caused by divine curses.

A BPD-free world is possible. People often underestimate what can be done over long periods of time with sustained, gradual effort. Perhaps BPD’s life is already growing short.

How Would We Understand People Without BPD?

What a scary idea! How could we ever understand people showing “borderline” symptoms without labeling them with BPD?!

How do we understand the problems of anyone we care about?

1) Listen to their story. Learn about what past and present experiences are causing their distress. Develop a shared understanding of their problems based on their history.
2) Learn about what they want to change in the future. Develop a shared understanding of their needs and dreame.
3) Understand fundamental human needs for security, dependence, respect, and independence.

These are the fundamental steps in the Formulation approach to emotional distress, as described here in the story of Emma:

People labeled “borderline” can be effectively helped without labeling them as BPD. But because of the reductionist ideology that has crippled the minds of too many mental health “professionals”, abolishing BPD without a replacement label may be a bridge too far. The Big Pharma profit incentives which maintain the need for medicalization of emotional distress present another obstacle.

The First Step Toward Abolishing BPD – A New Name

Supported by the public’s ignorance about what a precariously perched house of cards “BPD” really is, the profit motives of psychiatrists and Big Pharma will likely block a total abolition of BPD, even though BPD paradoxically never existed and does not exist today. Therefore, I suggest the intermediate step of renaming BPD, something which has already begun to happen for other pseudo-illnesses such as “schizophrenia”.

If done well, renaming BPD would accomplish multiple goals:

1) Undermine the false conceptualization of emotional distress as an illness that is consistent from person to person.
2) Emphasize that emotional distress varies along a continuum and that people labeled “X” are not always “X” (i.e. are not always distressed, but are vulnerable to stress).
3) Reduce stigma by introducing a fresh name without negative connotations.

Despite these hopeful goals, one might argue that replacing BPD with another name would lead to just as much stigma and misunderstanding.

But could a new name truly aspire to be as miserably uninformative as Borderline Personality Disorder?

Would BPD by any other name smell just as bad?

I doubt it.

Japan, Jim Van Os and the Abolition of Schizophrenia

I’ve gone through some brainstorms about what BPD could be renamed, drawing on the campaign against “schizophrenia” for ideas. Many people are calling for schizophrenia to be abolished, and Japan legally abolished schizophrenia about 10 years ago

(Yes, there really are no more “schizophrenics” in Japan. They have a new, less-stigmatizing name for psychotic distress, meaning “integration syndrome” in Japanese, and people undergoing psychotic episodes are no longer called schizophrenic. The entire Japanese government-recording and psychiatric-labeling system for psychosis has been changed. See here – http://www.schres-journal.com/article/S0920-9964(09)00140-6/abstract ).

Van Os renames schizophrenia, “Psychosis Susceptibility Syndrome” , or PSS. The name implies that psychotic experience occurs along a spectrum of severity, involves vulnerability to environmental stress, and that people who have been psychotic in the past are not always psychotic today. In this model, “schizophrenia” as a discrete illness is meaningless and false.

If BPD were renamed Emotional Dysregulation Susceptibility Syndrome, what would that mean? The EDSS concept would contrast with BPD as follows:

1) Spectrum, Not Illness: EDSS represents a spectrum or continuum of increasing vulnerability to emotional distress. Despite similar appearances, people vary along this spectrum both in degree and kind of distress experienced. People would have more or less “EDSS” in relation to others and themselves at different times. EDSS is therefore not one illness, but a spectrum of related conditions – it refutes the misrepresentation of BPD as an internally reliable illness.

2) Vulnerability, Not Illness: EDSS represents a heightened susceptibility or proneness to emotional distress, usually correlated with neglect and abuse in childhood. EDSS itself does not cause distressing symptoms; rather, it represents the heightened likelihood of environmental stress causing these distress experiences. Compared to BPD, EDSS gives more weight to what happens around a person, rather than to isolated non-contextual internal experiences. EDSS is a syndrome – again meaning it represents similar-appearing experiences which do not necessarily reflect a consistent underlying illness.

3) Recovery and Freedom, Not Management: EDSS represents a psychological state that someone can be in at a certain time of their life, but can grow out of and be free from at a later time. It is in no way a lifelong condition. With effective help, people have a good chance of moving out of the EDSS spectrum for good. This refutes one of the most damaging lies about BPD: That BPD is a life-long illness.

(If you could rename BPD, what would you call it and why? Or would you keep BPD? Let me know in the comments.)

A Psychodynamic Model of the EDSS Continuum

Drawing on my psychodynamic background, I conceptualize Emotional Dysregulation Susceptibility Syndrome as a continuum marked by a relative deficit of positive self/object images, combined with a predominance of all-bad images of self/other within a person’s mind. The deficit of good internalized experience and the predominance of all-bad self/other images would usually correlate with neglect, lack of love, abuse, or trauma caused by parents and peers in childhood and young adulthood. I developed this model fully here, drawing on the “master theorist” of borderline-spectrum conditions, Ronald Fairbairn:

The deficit of all-good images leads to the inability to comfort oneself when under stress (i.e. emotional dysregulation), and to the increased susceptibility to stress relative to most emotionally-healthy people who had more consistent past and present support. All the other distress experiences commonly labeled “borderline” – e.g. destructive acting out, lack of identity, rapidly shifting moods, extreme rage, splitting, etc. – would be understandable results of having to cope with the missing self-comforting functions that can only be provided by a predominance of good self/other images over bad self/other images, i.e. enough good experiences in one’s past to reassure oneself when under present-day stress.

These distress experiences would also be understood as present-day replayings of past trauma; i.e. as the projection of the all-bad self-object images internalized in childhood onto others in the present, which make the person experiencing EDSS feel that they are “bad” and others are rejecting or unavailable.

EDSS might also be conceptualized as the spectrum encompassing the “Out of Contact” through “Ambivalent Symbiotic” Phases in this 4-phase model:

These descriptions do not represent an illness, but rather a dynamic state of relating to oneself and others at a certain time. One can function at any point along the spectrum from almost Non-EDSS to very severe EDSS – i.e. from approaching a normal range of being able to comfort oneself and function well, with only occasional regressions into serious distress – down all the way to very severe EDSS, in which the distress experiences are constant and severe to the point that normal functioning is not possible. Hopefully that the paradigmatic differences between BPD and EDSS are clear.

You Don’t Have to Accept the BPD Label

I hope these ideas will be encouraging and provoke thought about whether BPD really is valid and useful. Replacing BPD might seem unthinkable now, but there were times when women voting seemed impossible, when black people being free seemed impossible, and when tobacco causing health problems seemed impossible. Radical change can happen. Often, the process leading to a dramatic change is gradual and unseen, like when decades-long pressure building under the Earth’s crust goes unnoticed before an earthquake.

If a small but growing number of people reject the BPD label, this process can build momentum toward renaming and/or abolishing BPD. I encourage everyone reading this who has ever been labeled “borderline” to consider that you no longer have to identify with or accept BPD, period.

If a psychiatrist labels or has labeled you as BPD, or if the voice of people calling you borderline is stuck in your mind, I encourage you to tell them something like this:

“The BPD label you’ve called me is a simplistic checklist of distress factors, factors which anyone under stress for long enough can experience to different degrees. There are no reliable genes, brain-scans, or other biomarkers which can identify so-called BPD. In fact, BPD is in no way a reliable classification; it is an “illness” fabricated out of thin air without a basis in real science.
There is therefore no proof that I have an illness like you say, or that there is anything innately wrong with my brain; most likely, I am reacting in a perfectly logical way to the stresses I’ve gone through. There are other, better ways to understand my problems, and I do not accept the false label of BPD that you are putting onto me. If I get enough help, I can fully recover and live the life that I want.”

Psychiatrists and therapists need to hear this from more of the people they call “borderline”!

Thus far on this blog, I have described my recovery from borderline symptoms and outlined a psychodynamic understanding of Borderline Personality Disorder.

Today I would like to take on some of the highly prevalent myths about BPD. These ideas circulate across the internet on forums, blogs, and webpages about BPD. To me, they are unreasonably pessimistic, scientifically baseless, and unhelpful.

Here are five myths that people newly diagnosed with BPD are often told:

Myth #1: Borderlines cannot become lastingly free from borderline symptoms (i.e. BPD can only be ameliorated, not removed).
Myth #2: Effective treatments that “cure” BPD have not yet been developed.
Myth #3: BPD is caused by genes and biology.
Myth #4: Medication and therapy are equally effective treatments for BPD.
Myth #5: BPD is a valid diagnosis and a real medical condition.

If you are upset by any of these ideas, you don’t have to continue reading – after all, I can’t force people to give up their view of BPD as incurable, genetically-based, and a valid scientific diagnosis. But if you are open to the possibility that rejecting these notions can be encouraging and useful, read on.

Myth #1: Borderlines cannot become lastingly free from borderline symptoms (i.e. BPD can only be ameliorated, not removed).

On some BPD blogs, one reads that BPD is a “life sentence”, that “there is no cure for BPD”, that “BPD symptoms can only be managed”, and so on. My reaction to these statements is pity. It is tragic that people who are already facing severe life challenges have their problems compounded by such unwarranted pessimism. It creates a vicious cycle, where people who are already struggling with real emotional problems are further discouraged by hearing – falsely – that they are unlikely to recover. This then exacerbates their real problems, leading to further discouragement, and so on.

Can I prove on this blog that BPD can be fully recovered from, as one can prove that water boils at 212 Farenheit? No. But what I do have is my own experience, plus a large amount of research on BPD gleaned from former BPD sufferers and therapists.

For the six year period from about 2003-2008, I suffered with all of the nine borderline symptoms in the DSM. It was absolutely hellish – most days were a psychological war, filled with constant anxiety, bleak depression, hopelessness about the future, suicidal thinking, feeling horribly alone, being unable to relate positively to anybody, and so on. Because I’ve been there, I understand where other blogs about BPD being so difficult are coming from. I describe my difficult experience more in post #3, “The Tragic Borderline Experience.”

But as of 2014, I have been developing increasingly good relationships and functioning better and better for the last 5-6 years. I don’t have any of my former borderline symptoms, nor do I fear they will recur. Most of the time, I’ve felt vigorous, alive, capable, motivated, and real. A small minority of the time, I feel worried and down, but not more than most people and not without real cause. In light of my past history, I feel that I have triumphed. I describe how this progress occurred in post #2, “How Did I Recover from BPD?”

This personal experience convinces me that BPD can be recovered from in a deep, lasting way. We only truly know what we directly experience, and that is my “proof”. My experience indicates that BPD can not only be ameliorated and managed – it can be fully dissolved, removed, and triumphed over.

Perhaps somebody reading this is saying, “Edward, how do we know you’re telling the truth? This whole blog could be a fantasy.” While that is untrue, let’s indulge that fantasy for a moment. 🙂 Taking my experience out of the equation, what other evidence says that borderlines have recovered to live good lives as non-borderlines?

Secondly, there are dozens of books with hundreds of case studies of borderlines who recovered. For example:

James Masterson – Psychotherapy of the Borderline Adult
Jeffrey Seinfeld – The Bad Object
Helen Albanese – The Difficult Borderline Patient: Not So Difficult To Treat
Peter Giovacchini – Borderline Patients, the Psychosomatic Focus and the Therapeutic Process
Bryce Boyer – Psychoanalytic Treatment of Schizophrenic and Characterological Disorders
Vamik Volkan – Six Steps in the Treatment of Borderline Personality Organization
William Meissner – Treatment of Patients in the Borderline Spectrum
Gerald Adler – Borderline Psychopathology and Its Treatment
Donald Roberts – Another Chance to Be Real: The Treatment of Borderline Personality Disorder
Harold Searles – My Work with Borderline Patients

These are some of the psychodynamic books that are my area of interest (if one added in CBT and DBT, you could come up with a much bigger list of books that are optimistic about BPD). These ten books alone contain about 40-50 case studies of borderline patients who recovered fully and/or made great improvements to become diagnostically non-borderline. I don’t recommend reading these books, because it is more useful to connect with real people. However, they show that many therapists have worked successfully long-term to cure patients with Borderline Personality Disorder. I doubt that all of these authors are colluding to lie about borderlines getting better 🙂

So, an increasing number of direct-experience accounts and professional-therapist accounts of BPD recovery are now available to provide hope. The question should no longer be whether borderlines can become non-borderline, but how better to provide them the resources to enable deep and lasting recovery.

Myth #2 : Effective Treatments that “Cure” BPD Have Not Yet Been Developed

As a medical word, “cure” is probably not the right word for an emotional condition like BPD. Perhaps one would do better to say “deep recovery”, “living the life you want”, “finding fulfillment and meaning”, “being free from constant emotional suffering”, etc. Whatever terms are used, there are treatments and support systems that make these things a real possibility for sufferers of BPD.

Since it is very similar to the first myth, I will not write about this idea at length. However, there are several effective treatments that can lead a person to no longer meet the criteria for BPD. My favorite approach is psychodynamic-psychoanalytic psychotherapy, of which all the books listed above under Myth #1 are examples. Reading the case studies in these books leaves little doubt that borderlines can become free from their symptoms. That’s not to say it’s easy or immediate; it takes years of work. But it’s possible for anyone.

Other effective approaches include DBT (Marsha Linehan’s approach), Mentalization Based Therapy (Peter Fonagy), and Transference Focused Psychotherapy (Otto Kernberg). I am not as familiar with these approaches, so cannot comment at length. However, many people with borderline issues have reported that they are very helpful, as can be seen at forums like http://www.PsychCentral.com . Debbie Corso’s blog gives a lot of information about DBT and how she used it to recover. I recommend the reader to check out her story, linked above.

Although some aspects of this report are suspect (since it is based on the medical-model version of BPD, and implies that it is partly a biologically-caused disorder, which I disagree with), it is encouraging in that it reports statistics such as:
– Over a 10-year period, over 90% of patients eventually experience a remission of BPD as defined by not meeting enough of the DSM criteria for the disorder.
– 78% of (formerly) borderline patients attain broadly-defined good psychosocial functioning over a 10-year period (defined as at least one meaningfully close relationship with a partner or friend, and good work/vocational functioning).

These numbers are based on about 300 borderline patients who were followed for 10 years after initial intake into a hospital in the Northeastern US. It’s not possible to generalize to any one person based on group statistics, but they show that improvement and remission from BPD is very possible. Many people diagnosed with BPD are still being indoctrinated with the idea that it is an incurable, life-long illness. It’s time to begin changing that attitude.

Myth #3: “BPD Is Primarily Caused by Genes and Biology”

This is a statement that I read now and start laughing. Often promoted by drug companies, hospitals and universities (funded by Big Pharma), or establishments psychiatrists, websites touting this viewpoint say, “We now know that BPD is caused by both genetic and environmental factors!” or, “A person with BPD has a broken brain!” or, “BPD has now been found to be 68.72% hereditary!”

To go back to one of my earlier articles, I’d ask the reader to consider the following:

BPD is based on 9 subjectively assessed symptoms. Jack could have symptoms 1 through 5 only. Jane could have symptoms 5 through 9 only. Both would be “borderline”, even though they shared only one symptom in common and have four unique symptoms each. For example, they could both have self-injurious acting out (e.g. being promiscuous or abusing a substance), but be completely different in their other symptoms.

The extreme biological determinists would say that Jack and Jane have the same “disease,” and that is it is genetic and biological, caused by misfiring neurons. This makes no sense. Patterns of complex human emotional problems that (in some cases) barely overlap cannot be reduced to a biologically-caused disease.

In my view, the motivation behind labelling BPD as a biologically-caused disorder is profit. Pharmaceutical companies want to sell more drugs, and to do so, they need to promote the myth that emotional problems originate in brain biochemistry. This is discussed further here:

As for BPD being hereditary, that is equally ridiculous. Firstly, the notion that a genetic percentage-contributor for the condition can be quantified is simply not true, given the complex way in which genes and environment interact. I recommend the reader to Evelyn Fox Keller’s outstanding book, “The Mirage of a Space Between Nature and Nurture”, for an explanation of this concept.

While constitutional vulnerability to stress may be a factor in who develops so-called “borderline” symptoms, that does not mean BPD runs in families due to genetic factors (although, it may certainly run in families due to generationally-transmitted abuse and neglect). In an earlier article, the way in which gene studies misrepresent BPD and other mental health conditions as biological diseases was discussed:

Given that medications only treat the anxiety and depression associated with BPD, rather than BPD itself, my position is that medications can at best be palliative. Palliative means they reduce symptoms to a limited degree, without treating the root cause of someone’s problems. At worst, medications can cause horrible side effects, waste money, and promote the fantasy that pills will solve long-standing personality problems.

I have never heard of a borderline who was cured by medication alone. But as discussed above, there is convincing evidence, both from first-person accounts of recovered borderlines, and from third-person accounts of therapists working with borderlines, that full lasting recovery from BPD can be achieved via psychotherapy, self-help, and human support in general. Therefore, psychotherapy and human support are the treatments of choice for BPD.

It should be noted that medications are not all bad. In my early years of coping with extreme rage and hopelessness, I used psychiatric medication for a limited time. It stopped me from being overwhelmed by anxiety. However, after entering therapy and stabilizing, I gradually titrated off the medication. In the big picture, medication was a very limited tool.

Myth #5: BPD is a valid diagnosis and a real medical condition.

It is time to reveal my true colors. I do not believe that BPD is a real disorder, although I believe all its symptoms are real and painful. Let me explain.

Saying that BPD exists is like saying that a certain group of stars in the sky are the “Big Dipper” constellation. There is nothing in nature that makes a constellation exist, only humans’ illusory projection of order into the stars’ positioning. In other words, a constellation itself is not a real external entity – it’s just an idea in people’s minds projected onto that external entity. It is a reification or simulacrum.

Likewise, BPD is an artificial construct. Like a constellation based on stars, BPD is based upon an artificial grouping of human behaviors, although there is nothing innately in those behaviors that makes it valid. Unlike constellations, BPD is even less reliable, because at least constellations are based on artificial groupings of clear physical entities. BPD, on the other hand, is based on subjectively assessed psychological-emotional symptoms which must reach a certain threshold intensity for inclusion. Why those nine symptoms were chosen for BPD (and not dozens of other possible symptoms), why it should be nine symptoms and not more or less, and when exactly each symptom is intense or different enough from “normality” for inclusion, are all mysterious, hard-to-answer questions.

More insidiously, these questions lay bare the fact that BPD is a nonscientific figment of psychiatrists’ imagination. I have no hesitation in saying this, despite having had all nine “borderline” symptoms myself. BPD as a medical condition is a fraud. It is richly ironic that the term “borderline” appears so often on this site, when I do not even believe in its validity.

However, as I noted in article #8 on the BPD diagnosis, BPD does have its uses. It does have some generally understood, if imprecise, connotations. One must admit that BPD means something to some people, although exactly what is not always clear. Because people insist on speaking about BPD as a valid medical diagnosis, I have found a way to think about it usefully. I usually translate “borderline” to mean that a person is struggling with some uncertain degree of severe emotional problems, often based on early neglect and/or abuse, and usually involving splitting in which negative perceptions of self and other are stronger than the positive self-and-other units. For me, this is more meaningful than the trite and superficial DSM diagnosis. This self-and-object theory is described here:

When I read on a blog that someone “has” BPD; my first thought is that this doesn’t tell me much about them. I am more interested in hearing about their personal history, what they are anxious about, their hopes for the future, what resources they are using to improve, etc. Those things are real. The main positive aspect of the BPD label is that it allows people to find effective help for the range of problems that are imperfectly described by that label.

I would like to share here the viewpoint of the British Psychological Society (Great Britain’s counterpart to the American Psychological Association) on the validity of personality disorders and other mental health diagnostic categories:

“One way of examining the validity of mental health diagnostic categories involves using statistical techniques to investigate whether people’s experiences actually do cluster together in the way predicted by the diagnostic approach. The results of this research have not generally supported the validity of distinct diagnostic categories. For example, the correlation amongst symptoms for specific mental disorders has been found to be no greater than if the symptoms had been put together randomly. Similarly, cluster analysis – a statistical technique for assigning people to groups according to particular characteristics – has shown that the majority of psychiatric patients would not be assigned to any recognizable group. Statistical techniques have also highlighted the extensive overlap between those diagnosed with one disorder and those diagnosed with another.”

(from the newsletter of the British Psychological Society (BPS), 2000, pg. 17. I have altered a few words to make the meaning clearer as applied to personality disorders, rather than psychoses, which the original paragraph also discussed. However, the essential meaning of the passage is unchanged.)

The BPS viewpoint implies that there are no clear boundaries between, and thus little validity or reliability within, each of the mental disorders of the DSM, including Borderline Personality Disorder.

Interestingly, if ones accepts that Myth #5 is indeed a myth (in other words, that BPD is not a valid medical condition), then it becomes necessary to reevaluate myths # 1 through 4. Here they are again:

If the placeholder “BPD” is actually an unreliable, fictional diagnosis, then many of these ideas cease to have meaning. One cannot become free from a condition that is not diagnostically valid; one cannot be cured of something that cannot be reliably identified, genes cannot cause a fictitious disorder, and medication and therapy cannot be compared for the treatment of a speculative phenomenon.

This is how I now think about BPD. Such an approach might seem invalidating. However, I empathize with people’s experience of being borderline as an identity, as I thought of myself that way for many years. What I am saying doesn’t mean that people’s suffering or experience is not real, only that the medicalization of emotional suffering, crystallized in BPD as a diagnosis, is suspect.

Paradoxically, I find rejecting the notion of BPD as a valid diagnosis to be encouraging and human. All nine symptoms listed under the BPD diagnosis are real and occur to different degrees in different people. But, I don’t believe someone suddenly “has” BPD when they have five out of nine of them.

Rather, I try to see human problems, including the nine so-called BPD symptoms, as existing on a complex continuum. On this spectrum, everyone’s problems are unique and cannot be compartmentalized into “diagnoses”. Such an approach is more human and respectful of individual differences. It’s not easy to think that way, since we are accustomed to think in categories and divisions. But I never liked how psychiatry labels many severely troubled people as “borderlines” when really, everyone’s problems are their own.

Some of these ideas might be controversial, especially this last myth. I don’t expect everyone to agree. If you have your own opinion, feel free to share it in the comments below. There’s a need for increasing dialogue, both about what can help people who are diagnosed with BPD improve, and also about the worth of the BPD diagnosis. Although it may be controversial, such dialogue may be interesting and useful, and can only have a positive effect for those diagnosed with BPD in the long-term.

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.